Dupilumab reduces SCS use in type 2 asthma regardless of prior exacerbations

Treatment with dupilumab reduces the use of systemic corticosteroids (SCS) in children with moderate-to-severe asthma, regardless of exacerbation history, according to a post hoc analysis of the VOYAGE and EXCURSION trials presented at APSR 2023.

“Repeated use of rescue SCS has long-term adverse effects, particularly as cumulative exposure increases,” said the researchers. “There is a need to reduce rescue SCS, especially in the paediatric asthma population.”

The 52-week VOYAGE study included children who received dupilumab 100 or 200 mg every 2 weeks (Q2W) by body weight or placebo. In the EXCURSION extension study, children who had previously completed VOYAGE were given dupilumab 100 or 200 mg Q2W or 300 mg Q4W by body weight for an additional 52 weeks in the EXCURSION study.

This analysis included children aged 6–11 years with moderate-to-severe type 2 asthma who had a blood eosinophil count of 150 cells/L or a fractional exhaled nitric oxide level of 20 ppb. In the year prior to VOYAGE, participants were stratified by the number of severe exacerbations (1 or ≥2) requiring rescue SCS. [APSR 2023, abstract APO9-381]

In both studies, patients treated with dupilumab had a reduced annualized severe exacerbation rate compared with placebo (VOYAGE: 0.143 vs 0.463; EXCURSION: 0.085 vs 0.089).

Among patients with ≥2 prior severe exacerbations, those treated with dupilumab achieved a lower rate of severe exacerbations than those treated with placebo in both the VOYAGE (0.477 vs 0.839) and EXCURSION studies (0.176 vs 0.195).

Based on these results, rescue SCS use was reduced among those on dupilumab vs placebo regardless of prior severe exacerbations in the VOYAGE study (0.156 vs 0.487 and 0.545 vs 0.966 for those with 1 or ≥2 prior severe exacerbations, respectively).

Similar results were observed during the EXCURSION study. There was a reduction in the use of rescue SCS in the dupilumab group vs the placebo group, irrespective of 1 or ≥2 prior severe exacerbations (0.85 vs 0.089 and 0.176 vs 0.195, respectively).

Moreover, dupilumab-treated patients had improvement in prebronchodilator percentage predicted forced expiratory volume in 1 second, regardless of exacerbation history, compared with placebo-treated patients, the researchers noted.

“Overall, dupilumab reduced rescue SCS exposure in children with uncontrolled, moderate-to-severe type 2 asthma as a result of reducing severe exacerbations, while improving lung function regardless of the number of prior severe exacerbations,” they concluded.